Beginning February 28, 2018, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy to deny payment of a select group of Pharmaceutical and Non-Pharmaceutical items. The list of items to be denied will be identified by National Drug Code (NDC) and includes, but is not limited to, convenience kits. Any bill identified as containing a charge for any such non-covered NDC will be denied in its entirety. A listing of non-payable NDCs will be available on DFEC's website at https://www.dol.gov/owcp/dfec/.

DEEOIC: New Policy - Effective 1/16/2018

Effective January 16, 2018, the Division of Energy Employees Occupational Illness Compensation Program (DEEOICP) is changing how it evaluates requests for Physical therapy, Occupational therapy, Speech therapy, and other rehabilitative therapy services. A DEEOIC Policy Bulletin has been published that explains the changes in more detail. The Bulletin includes guidance relating to initial therapy assessments, medical evidence necessary to support requests, maximum levels of coverage and locations where therapy can occur. Requests for rehabilitative therapy authorization may continue to be faxed to 800-882-6147.

Effective August 1, 2017, email addresses ending with @xerox.com will no longer be valid for contacting Conduent. Conduent email addresses end in @conduent.com.

DEEOIC Announcement- Enteral Formula

Effective May 1, 2017, Enteral Formula (Nutritional Supplements) now requires prior authorization. Enteral formulas are liquid preparations used for nutritional supplementation or replacement in patients who are unable to obtain adequate nutrition through their regular diet. These formulas are taken by mouth or through a feeding tube, and are used by the body for energy and to form substances needed for normal bodily functions. Failure to obtain prior authorization may delay reimbursement or result in a denial. Please click here to review this update.

DFEC Opioid Medication Letter of Medical Necessity Requirements

Beginning in August 2017, the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will require claims with newly prescribed opioid use (i.e. claims where an opioid has not been prescribed within the past 180 days, if ever) to have a completed and approved Letter of Medical Necessity (LMN) form on file for prescription authorizations after an initial 60 day period. Additionally, compounded medications containing opioids will require a completed and approved LMN prior to dispensing, effective June 26, 2017. This form will be made available to registered providers beginning in June 2017 at https://owcpmed.dol.gov/portal/main.do.
To submit the form, providers must click on the 'Provider' Link to the right of the FECA oval located at the top left of the home page, login with their user ID and password, and then click on the 'LMN Documents' link located in the left menu bar. For providers not yet registered, after clicking the 'Provider' link, click the 'Web Registration' link located in the left menu bar to register for web access. For providers not yet enrolled, click on 'Forms & Links' in the horizontal menu at the top of the home page to download the Provider Enrollment form and instructions. Authorizations for opioid medications will be limited to a maximum of 60 days, with initial fills and refills to be issued in no more than 30-day supplies. Beneficiaries already receiving opioid prescriptions will not be subject to the LMN requirement at this time. For additional information, please see the DFEC website at https://www.dol.gov/owcp/dfec/ for further information under the "Latest News" section.

DFEC: New Policy on Filling Non-maintenance Medications

Beginning May 2017, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy on filling non-maintenance medications for the treatment of work-related injury or illness. The program's policy will limit the fill of non-maintenance medications to 30 day increments. Additionally, refills cannot be obtained until 75% of the prescription timeline has passed. Maintenance medications (such as those used to treat chronic conditions like high blood pressure and asthma) will not be subject to these limitations. In determining what constitutes a maintenance medication, DFEC will be relying primarily on First Data Bank classifications. Physicians seeking to have the 30 day/75% fill requirement waived for non-maintenance drugs should submit a written request directly to the responsible DFEC district office because there is no method of requesting an exception through the Web Bill Processing Portal. Waiver of the fill requirements for non-maintenance drugs will be authorized on an exception basis only based on approval of the OWCP Chief Medical Officer or his/her designee.

DFEC Announcement - Herbal Supplements

Beginning March, 2017, in accordance with the discretion granted to DOL and delegated to the Office of Workers' Compensation Programs (OWCP), the Division of Federal Employees' Compensation (DFEC) is instituting a new policy for authorizing herbal supplements prescribed by physicians for treatment of work-related injuries or diseases. The Program's policy will be to not authorize payment for herbal supplements, unless a claimant's treating physician acquires prior authorization by submitting rationalized medical evidence that supports the herbal supplement's safety, effectiveness, and necessity. To implement this policy, OWCP will rely primarily on First DataBank (FDB) classification. Physicians wishing prior authorization for an herbal supplement should submit a written request directly to the responsible District Office as there is no form or other provision for authorization to be requested through the Web Bill Processing Portal. Herbal supplements are authorized only on an exception basis on approval of the OWCP Chief Medical Officer or his/her designee. For more information, please visit the DFEC website:https://www.dol.gov/owcp/dfec/PolicyOnHerbalSupplements.htm

DCMWC: Proposed Rule Making

On January 3, 2017, U.S. Department of Labor's Division of Coal Mine Workers' Compensation proposed a new rule to modernize medical benefit payments under the Black Lung Benefits Act. More information about the proposed rule, as well as information about the Black Lung program is available at http://www.dol.gov/owcp/dcmwc/.

DFEC Compounded Drugs Letter of Medical Necessity Requirements

Beginning in October 2016, the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will require all claims for prescription medications which contain a compounded drug to have a completed and approved Letter of Medical Necessity (LMN) on file for prescription authorizations submitted starting in early October. This form will be made available to registered providers beginning in October 2016 at https://owcpmed.dol.gov/portal/main.do.
To submit the form, providers must click on the 'Provider' Link to the right of the FECA oval located at the top left of the home page, login with their user ID and password, and then click on the 'LMN Documents' link located in the left menu bar. For providers not yet registered, after clicking the 'Provider' link, click the 'Web Registration' link located in the left menu bar to register for web access. For providers not yet enrolled, click on 'Forms & Links' in the horizontal menu at the top of the home page to download the Provider Enrollment form and instructions. Authorizations for compounded drug prescriptions will be limited to a maximum of 90 days, with initial fills and refills to be issued in 30 day supplies.

Billing for TENS Unit Supplies

Effective September 25, 2016, TENs Unit Supplies are no longer billable as individual services and must be billed under HCPCS code A4595 (Electrical stimulator supplies, 2 leads, per month). This allowance includes: electrodes (any type), conductive paste or gel, tape or other adhesive, adhesive remover, skin preparation materials, and batteries (9 volt or AA, single use or rechargeable), and a battery charger (if rechargeable batteries are used). If 2 leads are medically necessary, a maximum of only one unit will be allowed per month for Procedure Code A4595. If 4 leads are medically necessary, a maximum of two units will be allowed per month. The following HCPCs codes are no longer covered as separately billable services; A4365, A4450, A4452, A4455 A4456, A4558, A4630, A5120, A5126, and A6250. All TENs unit supplies must be billed using HCPCS Procedure Code A4595.

Updated DFEC Pharmacy Fee Schedule

Generic Medications: For services billed on or after July 1, 2016, the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will calculate the maximum allowable fee for generic drugs at 60% of the average wholesale price (AWP) plus a $4.00 dispensing fee.
Compound Medications: For services billed on or after July 1, 2016, the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will calculate the maximum allowable fee at:

50% of AWP of each NDC in the compounded drug, for compounded drugs containing three or fewer ingredients

30% of AWP of each NDC in the compounded drugs, for compounded drugs containing four or more ingredients

Compound Medication Initial Fill Duration

Effective July 1, 2016, the initial prescriptions for compound medication should be for a period not to exceed 90 days. Initial prescriptions for periods greater than 90-days may be subject to further review for medical necessity.

Dental Bills Announcement

Effective October 1, 2015, OWCP will only accept paper bills submitted on the newest version of the dental claim form (2012 American Dental Association J430D). Any bill submitted on an older version of the dental claim form will be returned to the provider and will not be submitted for processing. Additionally, all claims submitted on the new form must include the diagnosis code(s) for treatment (box 34a), a diagnosis pointer for each line billed (box 29a), and the appropriate diagnosis code list qualifier (box 34), regardless of the date the service was provided.

DEEOIC - The ICD-10 Transition and How it Affects DEEOIC Claims Processing

Important information for Energy Employees Occupational Illness Compensation Program medical providers is now available click here.

Effective October 1, 2015 Physicians must specify the laterality of a claimant's condition as applicable (e.g. right or left upper extremity, right or left kidney, right or left lung, etc initial encounter) in their medical documents and medical bills in order for a bill not to be denied.

Inpatient/Outpatient Billing Announcement

Effective August 31, 2015, The Office of Workers' Compensation Programs (OWCP) will no longer accept paper bills submitted on the UB92 Form. Bills submitted on the UB92 form will be returned to the provider with a letter of explanation indicating: "Incorrect Form - Submit on the proper form. Inpatient/Outpatient - Submit on UB04."

ICD-10 Announcement - Claimants

Your providers will continue to use ICD-9 codes for services provided before October 1, 2015. ICD-10 codes are required by your provider for services provided on or after October 1, 2015.

Dental Bills Announcement

Effective October 1, 2015, OWCP will only accept paper bills submitted on the newest version of the dental claim form (2012 American Dental Association J430D). Any bills submitted on an older version of the dental claim form will be returned to the provider and will not be submitted for processing.

Web Announcement Provider Type 75

Effective February 01, 2015 the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) will no longer accept CPT code 99070 when the service is billed by a licensed DME provider. If a DME provider submits a bill for DME services utilizing the procedure code 99070, the service will be denied.

Effective March 22, 2015, the Office of Workers' Compensation Programs (OWCP): Division of Federal Employees' Compensation (DFEC) and Division of Energy Employees Occupational Illness Compensation (DEEOIC) will require the NPI number in Block J on the CMS1500/OWCP1500 form for all surgical procedure codes. If the NPI number is missing, the line will be denied. If multiple providers participated in the surgery, supporting documentation must be submitted.

Effective February 22nd, 2015, the Office of Workers' Compensation Programs (OWCP), Division of Energy Employees Occupational Illness Compensation (DEEOIC) will implement a new reimbursement methodology which will be based on the Medicare Outpatient Prospective Payment System (OPPS). The new payment method will utilize Medicare’s Ambulatory Payment Classifications (APC) as well as the OWCP fee schedule.

The new payment method will apply to outpatient care in all acute care hospitals including general hospitals, freestanding rehabilitation hospitals and long-term care hospitals, with the exception of critical access hospitals and Maryland hospitals. When submitting the OWCP-04 form for Outpatient services, providers will be required to enter their Medicare Number in box 51. If the Medicare number is missing or invalid, the bill will be denied.

Toll Free Number Announcement

Effective January 2, 2015 the customer service number for questions related to provider enrollment, FECA bill payment, and FECA medical authorization status is changing to a new Toll Free Number from (850) 558-1818 to (844) 493-1966.

Re-Enrollment Announcement

The Office of Workers’ Compensation Programs (OWCP) will be conducting a Re-Enrollment of all actively enrolled OWCP Providers. The automated process will utilize the current enrollment data and conduct a verification using central public databases to include: provider demographics, NPI, taxonomy, specialty type, licensure, EFT, and proof of Medicare Certification where applicable.

Please Note: We have a new Enrollment fax number for providers who want to submit an Enrollment Application.
All completed online Enrollment Applications should faxed to: (888) 444-5335, and your application will be processed accordingly.

Effective October 1, 2014, the Office of Workers' Compensation Programs(OWCP), Division of Federal Employees Compensation (DFEC) will implement a new reimbursement methodology which will be based on the Medicare Outpatient Prospective Payment System (OPPS). The new payment method will utilize medicare's Ambulatory Payment Classifications (APC) as well as the OWCP fee schedule.

The new payment method will apply to outpatient care in all acute care hosptials including general hospitals, freestanding rehabilitation hospitals and long-term care hospitals, with the exception of critical access hospitals and maryland hospitals. When submitting an OWCP-04 form for outpatient services, providers will be required to enter their medicare number in box 51. If the medicare number is missing or invalid, the bill will be denied.

Attention DEEOIC DME Providers - The Division of Energy Employees Occupational Illness Compensation (DEEOIC) has released new guidelines concerning the authorization of durable medical equipment (DME). For information about these new guidelines, please click here.

Injection Service Limitation

The Division of Federal Employee’ Compensation Act (DFEC) has released new guidelines implementing service limitations for injection CPT codes 20550, 20551, 20552, 20553, and 20526, which goes into effect August 1, 2013.

CPT codes 20550 and 20551 will reimburse 4 encounters within a 12 month period with no additional encounters for the claimant after that year, and for the same case number.

CPT codes 20552 and 20553 will reimburse 10 encounters within a 12 month period with no additional encounters for the claimant after that year, and for the same case number.

CPT code 20526 will reimburse 3 injections within a 12 month period.

DOL Procedure Codes RP120, RP130 and RP200 are no Longer Available

Effective 08/01/2013, The Division of Federal Employees Compensation Act (DFEC) will no longer utilize DOL homegrown procedure codes RP120, RP130 AND RP200 (Pain Management). When rendering Pain Management services, providers are to bill and/or submit for prior authorizations using the appropriate HCPCS/CPT codes applicable for the services. Request for prior authorizations for pain management services should include but not be limited to a complete and detailed treatment plan.

Provider Search - New Web Feature

As of 03/30/08 a new feature called Provider Search is being offered to all three programs. This feature will help you generate a custom list of providers by entering criteria that describes what you are looking for. When searching the database the search may include the program name, provider type, specialty, provider name, city, state, and zip code. To get started click the Provider Search link in the Available Features section.